BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANTIUM

    MDR report key: 1013717 · Received March 12, 2008

    Report

    Report Number
    3004578807-2008-00074
    Event Type
    Injury
    Date Received
    March 12, 2008
    Date of Event
    January 1, 2008
    Report Date
    January 17, 2008
    Manufacturer
    DENTIUM
    Product Code
    DZE
    PMA / PMN Number
    K041368
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KN
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    DOCTOR REFUSED TO PROVIDE PT INFO IN DETAIL. ACCORDING TO OUR INVESTIGATION, THERE WAS NO DISCREPANCY ON OUR PROD. DATA CORRECTED. SEE SCANNED PAGES.

    Description of Event or Problem · 1

    THE IMPLANT FAILED DUE TO POOR BONE CONDITION. THE IMPLANT WAS EXPLANTED AFTER 6 MONTHS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTIUM ENDOSSEOUS DENTAL IMPLANT DZE DENTIUM MF FX4808

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention